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This is a retrospective analysis of a change in technique for endoscopic dacryocystorhinostomy (endo-DCR) surgery. The authors compared the outcomes of 55 patients between 2011 and 2013 with 187 from 2013 to 2020 who all underwent endo-DCR. In 2013 the authors changed their technique and instead of placing a saline-soaked Spongostan on the lateral wall of the nose over the rhinostomy site, they used one soaked in Depo-Medrol (methylprednisolone acetate). All patients were given steroid and antibiotic eyedrops and steroid nasal spray postoperatively. Anatomical success was defined as an open ostium and free passage of fluid into the nose on syringing. Functional success was defined as an absence of epiphora as reported by the patient. In the saline group, the anatomical and functional success rates were 90.9% and 83.6% respectively, compared with 94.6% and 93.4% in the steroid group. The difference was statistically significant (p<0.05) in functional success, but not anatomical success. There were no additional complications attributable to the steroid. The main drawback of the study is its retrospective nature and the inability to account for increased surgical experience biasing the results from a learning curve effect, as all operations were carried out jointly by the same two surgeons (otolaryngologist and oculoplastic surgeon) over the 10 year period. The authors do consider this and suggest that as the failure rate did not vary year by year, this is not a major factor. Although the beneficial nature of the steroid-eluting Spongostan cannot be proven without a masked randomised controlled trial, the study does provide good evidence of its effectiveness.

Introduction of steroid absorbed Spongostan in endoscopic dacryocystorhinostomy improves success rates.
Chen I, Ayalon H, Drabkin E, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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